Summary

John Barry’s The Great Influenza describes the background, course, and effects of the 1918 influenza pandemic, a disease that started in the heart of the United States and spread virtually all over the world. The spread of this disease was facilitated by the global reach of the First World War, when thousands of young men and women were displaced from their homes, gathered together in military cantonments, and then were shipped to all corners of the world. In this cycle of concentration and dispersion, the influenza virus was continually shared and spread to people who had no immunity to it. While Barry covers the disease and its effects with a chronological flow, his real focus is on the small group of American research physicians who tracked the disease and attempted to understand and ultimately control it.

Barry sets the context of the influenza story by examining different disciplines. His first is historical, as he documents the poor state of American medicine just prior to the start of the Progressive Era. Tracing the history of the medical profession, Barry shows it as a reflection of cultural and political developments in the 19th century. For example, anti-elitism of the Jacksonian Era prevented rigorous training and certification of physicians – anyone who wanted to claim they were a doctor could do so with little if any training (30). Later emphasis on professionalism and new development, spurred by the Progressive Era, led to increasing interest in medical developments in Europe, particularly in Germany. For a time, the best American doctors had to travel to Germany to receive decent medical training. Finally, a group of American physicians led by William Henry Welch established the John Hopkins University and later the Rockefeller Institute, both of which would eventually catch and then surpass the reputations of their European contemporaries. The establishment of these institutions occurred just in time to deal with the influenza pandemic. Barry culminates this section by describing the Flexner Report of 1910, a rigorous critique that recommended closure of 120 of the then 150+ medical schools in the US (84). After dealing with this historical foundation, Barry then embarks on an in-depth discussion of the science of virology (99-115), a complicated subject but one that is necessary for the reader to understand just what the physicians, scientists and flu victims of 1918 were dealing with.

Once into the main subject itself, Barry illustrates the societal response to the pandemic as a reflection of the close of the Progressive Era America. His description of the sudden burst of interest in advancing medical science is very much in line with Progressive Era philosophy of personal and societal improvement. In his comparison of the responses of different cities to the pandemic (Philadelphia and New York’s political machinery contrasted with San Francisco’s more robust public health administration), he shows the extent of corruption and influence in government, and how political patronage could have disastrous downstream effects. Barry’s discussion of the Flexner report places it in the context of period muckraking. Finally, his portrait of the growth of government and public coercion to support the war effort in general (such as the treatment of strikers and union organizers) and to comply with the ineffective influenza regulations of the time, are echoed in Christopher Capozzola’s Uncle Sam Wants You.

Commentary

Barry succeeds in making subjects that are complicated and largely dry into very compelling reading. His discussion of virology for example not only explains the complexities of virus structure, mutation and communication, but it does so in a manner that creates drama. He also makes compelling portraits of physicians and scientists such as Oswald Avery and Paul Lewis who might otherwise be viewed as single-minded laboratory drones. This dramatic treatment of scientific and technical subjects is reminiscent of Dava Sobel’s Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time. Sobel’s accomplishment was to take a subject that most would consider to be dry (in this case, the development of the world’s first accurate clock) and turn it into fine scholarly history that also has considerable popular appeal. It’s not often that a historian is able to strike that fine balance.

But Barry’s use of dramatic imagery to embellish his descriptions of virology becomes a little tedious in the latter half of the book. After pages and pages of descriptions of death the world over, the reader is looking for a “what happened” chapter. Unfortunately, this conclusion never really arrives. The final conclusion of a viral cause of influenza is almost an afterthought in the final chapter, and the epilogue of the fate of Paul Lewis – while compelling on its own – adds little to the story of the pandemic. Finally, Barry’s use of repetition as a literary technique (it was only influenza) overplays the intended effect.